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Gynaecological Maligancies

  • Gynaecological malignancies refer to cancers that originate in the female reproductive system, encompassing the uterus, cervix, ovaries, fallopian tubes, vulva, and vagina.

    These cancers are among the most prevalent in women worldwide, and their management requires a multidisciplinary approach integrating surgery, radiation therapy, chemotherapy, and targeted treatments.

    Early detection, precise diagnosis, and advanced treatment modalities significantly improve survival and quality of life.

    1. Cervical Cancer

      • Originates from the cervix (the lower part of the uterus).

      • Commonly linked to persistent infection with Human Papillomavirus (HPV).

      • Largely preventable through HPV vaccination and regular screening (Pap smear).

    2. Endometrial (Uterine) Cancer

      • Arises from the lining of the uterus (endometrium).

      • Most common in postmenopausal women.

      • Often associated with hormonal imbalance, obesity, and metabolic factors.

    3. Ovarian Cancer

      • Develops in the ovaries; often diagnosed late due to subtle or vague symptoms.

      • Includes epithelial, germ cell, and stromal tumors.

      • Genetic mutations like BRCA1/BRCA2 play a significant role.

    4. Vulvar Cancer

      • Involves the external genitalia; may arise from precancerous lesions.

      • Commonly affects older women.

    5. Vaginal Cancer

      • Rare; often secondary to cervical or vulvar cancer spread.

      • HPV infection and previous radiotherapy are risk factors.

  • Early symptoms may be non-specific. Women should seek medical advice for:

    • Abnormal vaginal bleeding (especially post-menopausal or between periods)

    • Persistent pelvic or abdominal pain

    • Unexplained weight loss or bloating

    • Changes in bowel or bladder habits

    • Unusual vaginal discharge or itching

    • Pain during intercourse

    • Diagnosis begins with a detailed clinical evaluation and imaging studies, followed by biopsy for histological confirmation. Key diagnostic tools include:

    • Pap smear & HPV testing (for cervical cancer)

    • Ultrasound / Transvaginal Sonography

    • CT, MRI, or PET-CT scans for staging

    • Endometrial sampling or biopsy

    • Tumor markers (e.g., CA-125 for ovarian cancer)

    • Treatment depends on the type, stage, and spread of cancer, as well as patient age and fertility considerations. Management typically involves a combination of:

    • 1. Surgery

    • Cervical Cancer: Radical hysterectomy with pelvic lymph node dissection.

    • Endometrial Cancer: Total hysterectomy with bilateral salpingo-oophorectomy.

    • Ovarian Cancer: Cytoreductive surgery (debulking) to remove visible tumor deposits.

    • Vulvar/Vaginal Cancer: Wide local excision or radical vulvectomy.

    • Whenever feasible, minimally invasive laparoscopic or robotic techniques are preferred for reduced morbidity and faster recovery.

    • 2. Radiation Therapy

    • Radiation plays a pivotal role in managing most gynaecological malignancies — either as primary treatment, adjuvant therapy (after surgery), or palliative care (to relieve symptoms).

    • Radiation Techniques Include:

    • External Beam Radiation Therapy (EBRT): Uses high-energy X-rays to treat the pelvis.

    • Brachytherapy (Internal Radiation): A highly targeted technique placing radioactive sources close to the tumor, especially in cervical and vaginal cancers.

    • IMRT (Intensity-Modulated Radiation Therapy): Shapes radiation precisely to minimize exposure to the bladder, bowel, and rectum.

    • IGRT (Image-Guided Radiation Therapy): Ensures accurate delivery and reduces side effects.

    • 3. Chemotherapy

    • Used either concurrently with radiation (chemoradiation), postoperatively (adjuvant), or for metastatic disease.
      Common agents include cisplatin, paclitaxel, and carboplatin.

    • 4. Targeted & Immunotherapy

    • Modern molecular approaches target specific tumor pathways (e.g., PARP inhibitors in BRCA-mutated ovarian cancer) or harness the immune system to recognize and destroy cancer cells.

    • High local control and cure rates, especially in cervical and endometrial cancers

    • Organ preservation in suitable cases

    • Non-invasive and precise treatment delivery

    • Can be combined safely with chemotherapy

    • Effective palliation in advanced or recurrent cases

    • Gynaecological cancers represent a diverse yet highly treatable group of malignancies when detected early and managed appropriately.

    • Radiation Oncology stands as one of the most powerful tools in their management — offering cure, organ preservation, and palliation through advanced and patient-focused techniques.

    • A coordinated multidisciplinary approach, modern imaging, precision radiotherapy, and compassionate care continue to redefine outcomes for women facing these challenging diseases.

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